胀 鼓胀之因经以病。厥气在下。营卫留止。寒气逆上。真邪相攻。两气相搏。乃合为胀。又曰。五脏阳已竭。
又曰合之于真。三合乃得。夫厥气在下者。此病根也。人身上下。阳布阴生则肺行而肾纳。何有厥。厥气在下。此肺不
行而肾失纳也。大气既厥。则营卫之流行经络者留止。而无根之阴气于是逆上。与真气相搏。寒气留而不行。乃合为胀
也。又藏阳即光气运之气。今藏阳已竭。则诸停而不行可知也。又曰合之于真三合而得。经既以胀为卫逆于营。而曰三
合而得。则虽在血脉而合经络合脏合腑。固阴阳俱有矣。然而要言之。则厥气在下。此胀之本也。故诊之其脉大坚以涩
者。胀也。大者。邪气之盛。坚者。邪气之实。两气相攻。胀而已成。故其脉大坚。此厥于阳而实也。涩者气血之虚不
能流利。此阴气之衰。阴气。真气也。此厥于阴而虚也。阴虚阳坚。中气已损。其胀必矣。是以涩而坚者。知其为阴在
脏。大而坚者。知其为阳在腑。皆以三合而得。于是有脉胀。肤胀。五脏胀。六腑胀。而又有水胀。鼓胀。肠覃。石瘢。
石水之别。要在明知逆顺。补虚泻实。所谓其道在一也。
五脏六腑。各有畔界。其病各有形状。营色循脉卫气之逆为脉胀。卫气并脉循分为肤胀。夫营行脉中。其精专。未
必即胀。卫则悚疾滑利而行分肉。故必由卫气之逆而后病及于营。则为脉胀。是以凡胀皆发于卫。若卫气逆而并于脉。
复循分肉之间。则为肤胀。然胀无常所。既胀于皮肤。则排脏腑而廓胸胁。凡膻中心主之宫城。胃之太仓。咽喉小肠之
传逆。胃之闾里门户。及五窍廉泉玉英之津道无不受胀也。故心胀者。烦心短气卧不安。肺胀者。虚满而喘嗽。肝胀者。
胁下满而痛引小腹。脾胀者。善哕。四肢烦 体重。不胜衣。卧不安。肾胀者。腹满引肾。央央然腰髀痛。胃胀者。腹
满胃脘痛。鼻闻焦臭妨于食。大便难。大肠胀者。肠鸣而痛濯濯。冬日重感于寒则飧泄不化。小肠胀者。少腹 胀引腰
而痛。膀胱胀者。少腹满而气癃。三焦胀者。气满于皮肤中。轻轻而不坚。胆胀者。胁肋下痛。口中苦。善太息。
水胀之始起也。目窠上微肿。如新卧起之状。其颈脉动时咳。阴股间寒。足肿胀。腹乃大。其水已成矣。以手按其
腹。随手而起如裹水之状。此其候也。水与肤胀。下六事病异而形相似。宜有以别之。目之下为目窠。颈脉之阳明人迎
也。水邪乘胃。故颈脉动。水之标在肺。故时咳。劂阴邪结于阴分。故阴股间寒。按水囊必随手而起。故病水者亦若是。
肤胀者。寒气客于皮肤之间。 然不坚。腹大身尽肿皮浓。按其腹 而不起。腹色不变。此其候也。寒气客于皮
肤。则阳气不行。气在气分。故有声若鼓。气本无形。故不坚。气无所不至。故腹大身尽肿。若因于水。则有水处肿。
无水处不肿。然有水则皮泽而薄。无水则皮浓。气在肤腠。按而散之。不能猝聚。故 而不起。腹色不变者。皮浓故也。
鼓胀者。腹胀身皆大。大与肤胀等。色苍黄腹筋起。此其候也。色苍黄者。赤皮浓腹也。即不变之义。但腹有筋起
为稍异耳。此病亦在气分。故名鼓胀也。
肠覃者。寒气客于肠外。与卫气相搏。因有所系。着恶气乃起。 肉乃生。大如鸡卵。及其成也。如怀子之状。大
者离脏。按之则坚。推之则移。月事以时下。覃延布而深也。寒气与卫气蓄积不行。汁沫所聚。留于肠外。致癖积 肉
生。离脏者越脏也。然邪客于肠外。不在胞中。故无妨于月事。
石瘕者。生于胞中寒气客于子门。子门闭塞。气不得通。恶血当泻不泻。 血留止。日以益大。状如怀子。月事不
行。皆生于女子。可导以下。胞即子宫也。男女皆有。男谓精室。女谓血海。寒既相搏。则子门闭塞。 血留止。其坚
如石。故曰石瘕。此妨月事。唯女子有之。
石水一症。岐伯本章无答。必阙文也。阴阳别论曰。阴阳结斜。多阴少阳曰石水。少腹肿。其义即此。述见阴阳中。
按内经治肿胀。首义以去菀陈 。开鬼门。洁净府。去菀陈 者。开其郁积也。开鬼门。发汗也。洁净府。利水也。
其治以表里上下分消为主。而至真大要论曰。诸湿肿满。皆属于脾。水热穴论曰。其本在肾。其末在肺。皆聚水也。又
曰。肾者。胃之关也。关不利故聚水。而从其类也。内经之言鼓胀。不惟五脏六腑。凡五运六气。司天在泉。胜复淫郁。
无不皆有。然无有不干于脾肺肾三脏者。盖脾主运化精微。肺主气而行治节。肾主五液而行水。故五气所化之液。悉属
于肾。五液所行之气。悉属于肺。转输二脏。利水生金。悉属于脾。所以肿胀之生。无不由三者之失职。然又必先由肾
气不足。下气厥上。三合而成。故其症虚实不伦。实中有虚。虚中有实。行其实当顾其虚。补其虚毋忘其实。而卒归于
大补脾肾以培根本。则得之矣。张介宾胀论。可以熟玩。姑举其要附此。
卒痛 卒痛诸症。种种不同。皆本寒邪之入经脉。环周不休。变而积留凝泣。或在脉外。或在脉中。或在肠胃膜
原。或在冲脉。或在厥阴。或在小肠。膜原络血之中。或五脏阴气厥逆。或从肠胃厥逆而上。或留为痹热坚干于小肠。
是以其证多端。在脉外者。卒然而痛。得炅则痛立止。惟重中于寒则痛久不散。在脉中者。与炅气相薄则脉满。故痛不
按。甚则寒气稽留。炅气从上则脉充大而血气乱。故痛甚不可按。在膜原之下血不得散。小络急引故痛。按之则血气散
而痛止。在冲脉者。随腹直上。寒逆而不通。故喘动应手。其在夹脊者。其气深。按亦不及。按无益也。其客背俞者。
脉泣血虚。血虚则痛。而其俞注于心。故相引而痛。若按之则热气至而痛亦止。客于厥阴之脉者。厥阴部胁肋小腹。血
泣脉急。故胁肋与小腹相引而痛也。客于阴股上及少腹上下相引。故腹痛引阴股。若寒气客于五脏。其阴气厥逆上泄。
阳气未入。故卒然痛。死不知人也。至气复反则乃生矣。客于肠胃。则厥逆上出。故痛而呕。客于小肠。不能成聚。故
腹痛后泄。又稽留其热于小肠。则痹热焦渴。肠中痛而坚干不得出。故痛而闭不通。然此皆寒气也。寒不入则脉不涩。
脉不涩而气乃流通矣。其征于色部者。白为寒。青黑为痛。亦视而可知也。其痛处脉坚而泣。及陷下亦扪而可得也。治
此者。温之而已。其热而闭者。斟酌下之而已。然有里虚而痛者。阴不足也。非养阴不可。上虚而痛。心脾伤也。非补
中不可。下虚而痛。脱泄亡阳也。非速救温补命门不可。此又以温而兼补之治也。孰云痛无补法哉。
肠 肠 之成。以阴不胜阳。阳入阴而乘之。使热郁下焦。传道之官失职。久而乃成。成则数欲大便而不得快。
或刮积而痛。或下 声。聚如蟹HT 。其病
如今之痢。实痢之别种也。痢以暑邪及夏月饮食滞腻停积而成。及秋而发。
亦有非时而发者。此非肠 之厉也。肠 。起足三阴厥热。留滞与手少阴手厥阴热邪移下而大肠受之。故其症虽与痢同。
而实为诸阴根柢之邪所致。何则。阴者地气也。其气主内。若起居不时。饮食不节。积虑房劳。皆足伤阴。阴伤则一身
之阳袭而下陷。因入五脏而乘阴位。阳陷于阴而不得舒升。则 满闭塞。久为肠 。夫下气厥而上。阳不胜阴则为 胀。
阴自乘阴。寒气聚沫留着则为 积。唯五脏阴伤。阴不胜阳。遂致阳陷下焦而阻其传道。是以为肠 也。经曰。因而饱
食。筋脉横解。肠 为痔。此症以热郁食塞。阳气不能流散而下乘尻阴。故为痔。痔亦肠 之类也。推此可以知矣。然
其症伤阴特甚。故多下血。而唯肾传脾者为最甚。以酒色两伤之故也。顾心肝 亦下血。而以酒伤脾者为酒积。所谓下
白沫者。如酒积之类。下纯血者。如手少阴足厥阴则乘之类。下脓血者。如肾移脾之类也。大约治法。肠胃自伤者。调
节饮食。升其阳气以和其阴。自肝来者。于土中泻水。自肾来者。温养命门。以升中土。此其法矣。
如疟 如疟者。内因正气不足。肝脾相乘。伤于营卫。而厥阴少阳心主寒热。又以司天六气胜复会遇之时因而感
发。如有疟状。或一日发。或间日发。大约阴气多而阳气少。其发日远。阳气多而阴气少。其发日近。此胜复相搏。盛
衰之节。应亦同法。盖寒热者阴阳之气也。迟速者。阴阳之性也。人之阴阳。则水火也。营卫也。内而心肾不交。木土
相克。则水火营卫。偏胜不和。阴阳和则血气匀。表里治。阴阳不和。则胜复之气。会遇之时刻制见矣。阳入之阴。则
阴不胜阳而为热。阴出之阳。则阳不胜阴而为寒。以阴阳之多少。为发作之迟速。然所谓正疟亦同者。阴阳出入之理也。
其不同者。有邪无邪之辨也。有邪则但由营卫之相会以为止作。无邪则直由水火之争胜以为盛衰。一在治邪。一在持正。
症同而治各不同矣。
积 积之始生。得寒乃生。厥乃成积。又曰。卒然多饮食则肠满。起居不节。用力过度。则络脉伤。阳络伤则血
外溢。阴络伤则血内溢。为役血。故肠胃之络伤则血溢于肠外。有寒汁沫与血相搏。则并合凝聚。不得散而积成矣。又
曰。内伤于忧恐。则气上逆。逆则六输不通。温气不行。且外中下寒。与此偕厥。凝血蕴里而不散。津液涩着而不去。
则积皆成矣。夫经络之气。得寒则厥。内伤肝肾脾。外厥寒气。两厥别先逆于下。而为足 。肢节痛而不便利也。于
是足胫寒血气凝涩。渐入肠胃。阳不化气。而肠外汁沫迫聚不散。兼卒暴多食。使肠胃运化不及。汁溢膜外。与血相搏。
又或起居用力过度。络伤血动。瘀血得寒。则食积血积所不免矣。
消瘅 消瘅之名。消则消铄肌肉。瘅为内有郁热。五脏之脉皆以微小者为消瘅。是五脏之精气不能充满于营。而
内有郁热以铄之也。故诊以脉实大者为顺。虽病久可治。若脉虚小坚则精枯血竭。不能耐久矣。盖消瘅之疾。皆起于不
足。是以灵枢言五脏皆柔弱者。善病消瘅。夫皆柔弱者。云是天元形体不充也。大气不足。五脏气馁。则阴虚生内热。
内热不解。则外消肌肉。若肥贵人则膏粱甘脆发热以致之。亦谓之消瘅。此病与三消异。盖此以心肾肝三经之阴虚生热
所致。故所谓热中消中者。其不可服芳草石药也。若服之则撄其发癫发狂。使急疾坚劲之气。激之为剽悍。不重使木克
土尽乎。故经以为服此者。甲乙日更论也。
内经消自为一种。即后世所谓三消也。如气厥论之肺消鬲消。奇病论之消渴。此上消也。多饮而渴不止者也。脉要
精微论。痹成为消中。师传篇胃中热则消谷。令人善饥。此中消也。溲便频而膏浊不禁。肝肾主之。此下消也。夫三消
之成。皆以水火不交。偏胜用事。燥热伤阴之所致。而要之五行之气相乘。阳胜固能消阴。阴胜亦能消阳。如风木乘二
阳胃为肌肉风消。心移寒于肺饮一溲二为肺消。则亢阳之衰而金寒水冷之为也。故由其燥热伤阴而气不化水为消。亦由
阴邪偏盛。阳不帅阴而水不化气为消。其谓一也。
瘅又为一症。有脾瘅。有胆瘅。脾瘅者。口甘肥美之所发也。肥令人内热。甘令人中满。中满郁热。其气上溢。转
为消渴。内经治之以兰。除陈气也。兰草性味甘寒。能利水道。其清气能生津止渴。可除陈积蓄热也。胆瘅者。口苦。
以肝取决于胆。而数谋虑不决则胆气虚。虚则其气上溢。而口为之苦。胆之脉会于咽也。
鼓胀的成因，经典记载为：厥逆之气在下部停留，营气和卫气运行停滞。寒气向上逆行，正气与邪气相互攻冲，两股气流相互搏结，从而合而为胀病。又说：五脏的阳气已经衰竭。
又说：必须结合真气来看，经过“三合”才能确诊。所谓“厥气在下”，这是疾病的根本所在。人体上下之间，阳气布散、阴气滋生，则肺气宣发而肾气摄纳正常，哪里会有厥逆呢？现在厥气在下，说明肺失宣发而肾失摄纳。大气既已厥逆，那么在营卫中流行于经络的气机就会停滞，无根之阴气于是向上逆行，与真气相搏结。寒气留滞而不行，于是合而为胀病。所谓的“脏阳”，即推动脏腑功能运行的阳气。如今脏阳已竭，那么各种停聚不行的病理状态就可想而知了。又说“结合真气，三合而得”，既然经典认为胀病是卫气逆行侵犯营气，又说是“三合而得”，那么即使病变在血脉，也会结合经络、结合脏、结合腑，因此阴阳两方面都涉及到了。然而简而言之，厥气在下，是胀病的根本。所以诊察时，如果脉象大而坚涩，就是胀病。脉大，代表邪气盛；脉坚，代表邪气实。两气相攻，胀病已成，所以脉象表现为大而坚。这是厥气在阳分且属实证。脉涩，代表气血虚弱不能流利运行，这是阴气衰微的表现。这里的阴气指真气，这是厥气在阴分且属虚证。阴虚而阳坚，中气已受损，胀病必然发生。因此，脉涩而坚，可知病在阴分而在脏；脉大而坚，可知病在阳分而在腑。这些都是通过“三合”来确定的。于是有脉胀、肤胀、五脏胀、六腑胀，又有水胀、鼓胀、肠覃、石瘕、石水的区别。关键在于明确辨别逆顺，采用补虚泻实的方法。这就是所说的治疗原则是一致的。
五脏六腑各有界限，其病症各有不同的形态表现。营气循行于脉中，卫气逆行导致脉胀；卫气并入脉中并循行于分肉之间导致肤胀。营气行于脉中，其气精专，不一定立即引起胀病。卫气则迅疾滑利地行于分肉之间，所以必须由卫气逆行之后，病及于营，才形成脉胀。因此凡是胀病都发源于卫气。如果卫气逆行并并入脉中，又循行于分肉之间，就形成肤胀。然而胀病没有固定的部位，既然胀于皮肤，就会排挤脏腑，廓清胸胁。凡膻中（心包络所在之处）、胃（太仓）、咽喉、小肠的传导通道、胃的门户，以及五窍、廉泉、玉英等津液通道，无不受到胀病的影响。所以，心胀的症状是心烦、短气、卧睡不安；肺胀的症状是胸部虚满、喘息咳嗽；肝胀的症状是胁下满痛并牵引小腹；脾胀的症状是容易呃逆、四肢烦扰沉重、穿衣感到负担重、卧睡不安；肾胀的症状是腹部满闷并牵引腰部，腰部和大腿根部疼痛；胃胀的症状是腹部满闷、胃脘痛、鼻闻焦臭味、妨碍进食、大便困难；大肠胀的症状是肠鸣且疼痛有声，冬天再次受寒则出现完谷不化的泄泻；小肠胀的症状是小腹胀满并牵引腰部疼痛；膀胱胀的症状是小腹满闷且小便不通畅；三焦胀的症状是气充满于皮肤之中，轻轻按之但不坚硬；胆胀的症状是胁肋下疼痛、口苦、喜欢叹气。
水胀刚开始发生时，眼睑上方微微肿胀，像刚睡醒的样子，颈部人迎脉搏动，时常咳嗽，大腿内侧感觉寒冷，足部肿胀，腹部随之变大，此时水邪已成。用手按压腹部，随手而起，像包裹着水袋一样的状态，这就是它的征候。水胀与肤胀，下面列举的六种疾病虽然病因不同但外形相似，应当加以鉴别。目下的部位称为目窠，颈部的动脉是人迎穴，属于阳明经。水邪侵犯胃，所以颈部脉搏跳动；水邪的标在肺，所以时常咳嗽；厥阴邪气结于阴分，所以大腿内侧寒冷。按压水囊必定随手而起，所以患水病的人也是如此。
肤胀是由于寒气客居在皮肤之间，空空然但不坚硬，腹部肿大，全身浮肿，皮肤增厚，按压腹部凹陷不起，腹部颜色不变，这就是它的征候。寒气客居在皮肤，阳气就不能运行。气停留在气分，所以发出如击鼓般的声音。气本来无形，所以按之不坚硬。气无所不到，所以腹部肿大、全身浮肿。如果是因水引起的，则有水的地方肿，无水的地方不肿。然而有水则皮肤润泽而薄，无水则皮肤增厚。气在肤腠之间，按压则散开，不能突然聚集，所以凹陷不起。腹部颜色不变，是因为皮肤增厚的缘故。
鼓胀的症状是腹部和身体都肿大，大小与肤胀相等，面色苍黄，腹部青筋暴露，这就是它的征候。面色苍黄，是指赤色被厚皮掩盖的意思，即不变色的含义，只是腹部有青筋暴露稍微有些不同罢了。这个病也在气分，所以名叫鼓胀。
肠覃，是寒气客居在肠外，与卫气相搏结，因为有所系连，附着恶气而生，息肉乃生。初起如鸡蛋大小，等到长成后，像怀孕的样子。大的时候离开脏器，按压则坚硬，推之可以移动，月经仍然按时来潮。“覃”意为蔓延分布且深在。寒气与卫气蓄积不行，汁沫聚集，留于肠外，导致癖积息肉生长。离开脏器是指越过了脏器。然而邪气客居在肠外，不在胞宫（子宫）中，所以不妨碍月经。
石瘕，生于胞宫（子宫），寒气客居在子门（宫颈口）。子门闭塞，气不得通畅，恶血应当排出却未排出，瘀血留滞停止，一天天增大，形状像怀孕，月经不来。这都发生在女子身上，可以用导引通下的方法治疗。胞即子宫，男女都有，男子称为精室，女子称为血海。寒邪相搏，导致子门闭塞，瘀血留滞，其坚硬如石，所以叫石瘕。这会影响月经，只有女子才有此病。
石水这一症，岐伯在本章中没有回答，一定是缺文。《阴阳别论》说：“阴阳结斜，多阴少阳曰石水，少腹肿。”其义理就在这里，论述见于阴阳篇中。
按《内经》治疗肿胀，首要意义在于去除郁积的陈腐之物，开发汗孔，洁净膀胱。去除郁积陈腐之物，是开通郁结积聚；开发汗孔，是发汗；洁净膀胱，是利水。治疗以表里上下分消为主。而《至真要大论》说：“诸湿肿满，皆属于脾。”《水热穴论》说：“其本在肾，其末在肺，皆聚水也。”又说：“肾者，胃之关也。关门不利，故聚水而从其类也。”《内经》关于鼓胀的论述，不仅涉及五脏六腑，凡五运六气、司天在泉、胜复淫郁，无不皆有，然而没有不牵连到脾、肺、肾三脏的。因为脾主运化精微，肺主气而行治节，肾主五液而行水。所以五气所化的津液，都属于肾；五液所运行的气，都属于肺；转输这两脏，利水生金，都属于脾。所以肿胀的产生，无不是由于这三脏失职造成的。然而又必须先由肾气不足，下气厥逆上行，经过“三合”而成。所以其症状虚实混杂，实中有虚，虚中有实。治疗实证应当顾护其虚，补益虚证不要忘掉其实，最终归结为大补脾肾以培固根本，这样就对了。张介宾的《胀论》，可以仔细研读，姑且举其要点附于此。
卒痛的各种症状，种种不同，都源于寒邪侵入经脉，环周不休，变化而积留凝泣。有的在脉外，有的在脉中，有的在肠胃膜原，有的在冲脉，有的在厥阴，有的在小肠。在膜原络血之中，或五脏阴气厥逆，或从肠胃厥逆而上，或留为痹热坚干于小肠。因此其证候多种多样。在脉外的，突然疼痛，得到温热则疼痛立即停止，只有再次严重受寒则疼痛久久不散。在脉中的，与热气相薄则脉满，所以疼痛拒按。严重时寒气稽留，热气从上而来则脉充大而血气紊乱，所以疼痛剧烈不可按压。在膜原之下，血液不得散开，小络脉紧急牵引所以疼痛，按压则血气散开而疼痛停止。在冲脉的，随腹部直上，寒气逆行而不通，所以喘动应手。在夹脊部位的，其气深，按压也达不到，按压无益。客居在背俞穴的，脉道涩滞血虚，血虚则痛，而其俞穴注于心，所以相互牵引而痛，若按压则热气到达而疼痛也停止。客居在厥阴脉的，厥阴经循行于胁肋和小腹，血涩脉急，所以胁肋与小腹相互牵引而痛。客居在阴股上部及小腹上下相互牵引，所以腹痛牵引阴股。如果寒气客居在五脏，其阴气厥逆上泄，阳气尚未入内，所以突然疼痛，昏死不知人，直到气回复反还才苏醒。客居在肠胃的，则厥逆之气上出，所以疼痛伴呕吐。客居在小肠的，不能完成食物的聚化，所以腹痛后泄泻。又若将热邪稽留于小肠，则痹热焦渴，肠中疼痛且坚硬干燥不得排出，所以疼痛且便秘不通。然而这都是寒气所致。寒邪不入则脉不涩，脉不涩则气乃流通。其反映在面色上的，白色为寒，青黑色为痛，观察即可知道。其疼痛处脉象坚涩，以及陷下的部位，也可以摸到。治疗这些，温补即可。对于热而闭结的，斟酌使用下法即可。然而有里虚而痛的，是阴不足，非养阴不可。上虚而痛的，是心脾受伤，非补中气不可。下虚而痛的，是脱泄亡阳，非速救温补命门不可。这也是以温兼补的治疗方法。谁说痛证没有补法呢？
肠澼的形成，是由于阴不胜阳，阳入阴而乘之，使热郁结于下焦，传化之官失职，久而久之乃成。形成后则多次想大便却不得畅快，或者刮积而痛，或者下痢有声，积聚如蟹沫。这种病就像现在的痢疾，是痢疾的一种别型。痢疾是由暑邪及夏月饮食滞腻停积而成，到了秋天发作。也有非时而发的，这不是肠澼的厉害情况。肠澼，起于足三阴经的厥热留滞，与手少阴、手厥阴的热邪移下而大肠受之。所以其症状虽然与痢疾相同，但实际上是由诸阴根柢的邪气所致。为什么呢？阴者地气也，其气主内。如果起居不时，饮食不节，积虑房劳，都足以伤阴。阴伤则一身之阳袭而下陷，因而进入五脏而乘犯阴位。阳陷于阴而不能舒升，则痞满闭塞，久则为肠澼。如果下气厥逆而上，阳不胜阴则为痞胀；阴自乘阴，寒气聚沫留着则为痞积。唯有五脏阴伤，阴不胜阳，遂致阳陷下焦而阻碍其传化功能，这才是肠澼。经文说：“因而饱食，筋脉横解，肠澼为痔。”此症因热郁食塞，阳气不能流散而下乘尻阴，所以形成痔疮。痔疮也是肠澼的一类。推此可以知道了。然而此症伤阴特别严重，所以多有下血，而唯肾传脾者为最甚，这是由于酒色两伤的缘故。顾念心肝也下血，而以酒伤脾的为酒积，所谓下白沫的，如同酒积之类；下纯血的，如同手少阴、足厥阴相乘之类；下脓血的，如同肾移脾之类。大约治疗方法：肠胃自伤的，调节饮食，升其阳气以和其阴；自肝来的，于土中泻水；自肾来的，温养命门，以升中土。这就是它的方法。
如疟，内因正气不足，肝脾相乘，伤于营卫，而厥阴、少阳、心主寒热，又以司天六气胜复会遇之时因而感发，如有疟状。或一日发，或间日发。大约阴气多而阳气少，其发作间隔日远；阳气多而阴气少，其发作间隔日近。这是胜复相搏，盛衰的节律，应该也是同样的法则。盖寒热是阴阳之气，迟速是阴阳之性。人的阴阳，即是水火，即是营卫。内而心肾不交，木土相克，则水火营卫偏胜不和。阴阳和则血气匀，表里治；阴阳不和，则胜复之气，会遇的时刻制约显现。阳入之阴，则阴不胜阳而为热；阴出之阳，则阳不胜阴而为寒。以阴阳的多少，作为发作的迟速。然而所谓正疟也相同的，是阴阳出入的道理。其不同的，是有邪无邪的辨别。有邪则只由营卫的相会以为休止发作，无邪则直接由水火之争胜以为盛衰。一在治邪，一在扶正，症状相同而治疗各不相同。
积的开始生成，得寒乃生，厥逆乃成积。又说：突然多吃饮食则肠满，起居不节，用力过度，则络脉受伤。阳络伤则血外溢，阴络伤则血内溢，成为瘀血。所以肠胃的络脉受伤则血溢于肠外，有寒汁沫与血相搏，则并合凝聚，不得散而积成矣。又说：内伤于忧恐，则气上逆，逆则六输不通，温气不行。且外中下寒，与此偕厥，凝血蕴里而不散，津液涩着而不去，则积皆成矣。夫经络之气，得寒则厥。内伤肝肾脾，外厥寒气，两厥分别先逆于下，而为足胫寒，肢节痛而不便利。于是足胫寒血气凝涩，渐入肠胃，阳不化气，而肠外汁沫迫聚不散。兼卒暴多食，使肠胃运化不及，汁溢膜外，与血相搏。又或起居用力过度，络伤血动，瘀血得寒，则食积血积所不免矣。
消瘅的名称，消是指消铄肌肉，瘅是指内有郁热。五脏的脉象都以微小者为消瘅，这是五脏的精气不能充满于营，而内有郁热以销铄之。所以诊察以脉实大为顺，虽病久可治。若脉虚小坚则精枯血竭，不能耐久。盖消瘅之疾，皆起于不足。所以《灵枢》说五脏皆柔弱者，善病消瘅。所谓皆柔弱者，是说先天形体不充。大气不足，五脏气馁，则阴虚生内热。内热不解，则外消肌肉。如果肥贵人食用膏粱甘脆发热以致之，也称为消瘅。此病与三消不同，盖此病以心、肾、肝三经之阴虚生热所致。所以所谓热中、消中者，其不可服芳草石药。如果服用则会引发癫狂，使急疾坚劲之气，激发为剽悍，不重使木克土尽乎。所以经文认为服用此药者，会在甲乙日更变论述。
《内经》的消病自为一类，即后世所谓的三消。如《气厥论》的肺消、鬲消，《奇病论》的消渴，这是上消，多饮而渴不止。《脉要精微论》痹成为消中，《师传篇》胃中热则消谷，令人善饥，这是中消。溲便频而膏浊不禁，肝肾主之，这是下消。夫三消的形成，皆以水火不交，偏胜用事，燥热伤阴所致。而要之五行之气相乘，阳胜固能消阴，阴胜亦能消阳。如风木乘二阳胃为肌肉风消，心移寒于肺饮一溲二为肺消，则是亢阳之衰而金寒水冷为之。所以由其燥热伤阴而气不化水为消，也由阴邪偏盛，阳不帅阴而水不化气为消，其谓一也。
瘅又为一症，有脾瘅，有胆瘅。脾瘅者，口甘肥美之所发也。肥令人内热，甘令人中满。中满郁热，其气上溢，转为消渴。《内经》治疗之以兰草，除陈气也。兰草性味甘寒，能利水道，其清气能生津止渴，可除陈积蓄热也。胆瘅者，口苦。以肝取决于胆，而数谋虑不决则胆气虚，虚则其气上溢，而口为之苦。胆之脉会于咽也。
Distension (Zhang)
The etiology of drum distension (Guzhang), as recorded in the classics, is: Jue Qi (rebellious qi) stagnates in the lower part, Ying Qi (nutritive qi) and Wei Qi (defensive qi) remain stagnant. Cold pathogen rebels upward, Zheng Qi (healthy qi) and Xie Qi (pathogenic qi) attack each other, the two forces contend, thereby combining to form distension. It is also stated: The Yang Qi of the five Zang organs has been exhausted.
It is further stated: One must correlate with Zhen Qi (true qi); only through "three combinations" can it be confirmed. The so-called "Jue Qi in the lower part" is the root of this disease. In the human body, when Yang Qi spreads and Yin Qi generates, Lung Qi disseminates and Kidney Qi grasps normally; how could there be Jue? Now that Jue Qi is in the lower part, it indicates that Lung Qi fails to disseminate and Kidney Qi fails to grasp. Since the Great Qi has rebelled, the Qi circulating in the Ying and Wei within the meridians remains stagnant, and rootless Yin Qi rebels upward, contending with Zhen Qi. Cold pathogen stays and does not move, thus combining to form distension. The so-called "Zang Yang" refers to the Yang Qi that drives the functional activities of the Zang organs. Now that Zang Yang is exhausted, it can be understood that various pathological states of stagnation occur. It is also stated "correlate with Zhen Qi, obtained through three combinations." Since the classics consider distension as Wei Qi rebelling against Ying Qi, and say it is "obtained through three combinations," then even if the lesion is in the blood vessels, it combines with meridians, Zang, and Fu organs; thus, both Yin and Yang are involved. However, briefly speaking, Jue Qi in the lower part is the root of distension. Therefore, upon diagnosis, if the pulse is large, firm, and choppy, it indicates distension. A large pulse signifies excess of pathogenic factors; a firm pulse signifies solidity of pathogenic factors. The two forces contend, distension is formed, hence the pulse is large and firm. This indicates Jue in the Yang aspect and excess syndrome. A choppy pulse signifies deficiency of Qi and Blood unable to flow smoothly, indicating decline of Yin Qi. Here, Yin Qi refers to Zhen Qi; this indicates Jue in the Yin aspect and deficiency syndrome. Yin deficiency with Yang firmness implies damage to Middle Qi, so distension must occur. Thus, a choppy and firm pulse indicates Yin pathology in the Zang; a large and firm pulse indicates Yang pathology in the Fu. All these are determined through "three combinations." Consequently, there are Mai Zhang (pulse distension), Fu Zhang (skin distension), Five Zang Distensions, Six Fu Distensions, and distinctions among Shui Zhang (water distension), Gu Zhang (drum distension), Chang Qin (intestinal polyps), Shi Xia (stone mass), and Shi Shui (stone water). The key lies in clearly distinguishing between rebellion and compliance, employing tonification for deficiency and purgation for excess. This is what is meant by saying the therapeutic principle is consistent.
The Five Zang and Six Fu organs each have their boundaries, and their diseases present with distinct morphological characteristics. Ying Qi circulates within the vessels; rebellion of Wei Qi causes Mai Zhang (pulse distension); Wei Qi merging into the vessels and circulating between the muscle intervals causes Fu Zhang (skin distension). Ying Qi moves within the vessels, its Qi being refined and specialized, and may not immediately cause distension. Wei Qi moves swiftly and smoothly between the muscle intervals; therefore, only after Wei Qi rebels and the pathology reaches Ying Qi does Mai Zhang form. Hence, all distensions originate from Wei Qi. If Wei Qi rebels and merges into the vessels, yet also circulates between the muscle intervals, Fu Zhang results. However, distension has no fixed location; once distended in the skin, it displaces the Zang and Fu organs and expands the chest and hypochondrium. All areas such as Dan Zhong (palace city of the Pericardium), Wei (Grand Granary), throat, small intestine transmission pathways, stomach gates, and the fluid channels of the five orifices, Lian Quan, and Yu Ying are subject to distension. Therefore, Heart Distension presents with vexation, shortness of breath, and restlessness in sleep; Lung Distension presents with empty fullness in the chest, wheezing, and coughing; Liver Distension presents with fullness and pain under the ribs radiating to the lower abdomen; Spleen Distension presents with frequent hiccups, irritability and heaviness of the four limbs, difficulty wearing clothes, and restlessness in sleep; Kidney Distension presents with abdominal fullness radiating to the kidneys, and aching pain in the waist and thighs; Stomach Distension presents with abdominal fullness, epigastric pain, olfactory hallucinations of burnt odor, food aversion, and difficult defecation; Large Intestine Distension presents with borborygmus and gurgling pain, and if exposed to cold in winter, leads to undigested diarrhea; Small Intestine Distension presents with lower abdominal fullness radiating to the waist and pain; Bladder Distension presents with lower abdominal fullness and strangury; San Jiao Distension presents with Qi filling the skin, feeling light but not hard upon pressure; Gallbladder Distension presents with pain under the costal margin, bitter taste in the mouth, and frequent sighing.
At the onset of Water Distension, the upper eyelids swell slightly, resembling the appearance after waking up. The Ren Ying pulse at the neck throbs, accompanied by occasional coughing, coldness in the inner thighs, swelling of the feet, and subsequent abdominal enlargement, indicating that water retention has established. Pressing the abdomen causes it to rise immediately, resembling a bag filled with water; this is the sign. Water Distension and Skin Distension, along with the six conditions listed below, differ in etiology but share similar appearances, requiring differentiation. The area below the eye is called Mu Ke. The neck pulse is Ren Ying, belonging to the Yangming channel. Water pathogen attacks the Stomach, causing neck pulse throbbing; the manifestation of water is in the Lung, causing occasional coughing; Jueyin pathogen knots in the Yin division, causing coldness in the inner thighs. Pressing a water-filled sac always rises immediately; thus, patients with water disease exhibit similar signs.
Skin Distension occurs when cold pathogen lodges between the skin. It feels hollow but not hard, with an enlarged abdomen and generalized edema, thickened skin, depression upon pressing that does not rebound, and unchanged abdominal color. This is the sign. When cold pathogen lodges in the skin, Yang Qi cannot circulate. Qi remaining in the Qi division produces sounds like drumbeats. Qi is inherently formless, hence not hard upon pressure. Qi pervades everywhere, causing abdominal enlargement and generalized edema. If caused by water, swelling occurs only where water accumulates. Water causes smooth, thin skin; absence of water causes thickened skin. Qi in the subcutaneous tissue disperses upon pressure and cannot suddenly gather, hence depression does not rebound. Unchanged abdominal color is due to thickened skin.
Drum Distension presents with enlargement of both the abdomen and the body, equal in size to Skin Distension, with a sallow-yellow complexion and visible abdominal veins. This is the sign. Sallow-yellow indicates redness concealed by thick skin, meaning unchanged color, except for the slight difference of visible abdominal veins. This disease also resides in the Qi division, hence named Drum Distension.
Chang Qin (Intestinal Polyps/Masses): Cold pathogen lodges outside the intestines, contending with Wei Qi. Due to adhesion, evil Qi attaches and grows, forming fleshy masses. Initially the size of a chicken egg, it eventually resembles pregnancy. When large, it separates from the viscera; pressing makes it hard, pushing moves it, and menstruation continues on time. "Qin" means spreading deep. Cold and Wei Qi accumulate and fail to move; juices and froth gather outside the intestines, leading to masses. Separating from viscera means surpassing them. Since the pathogen is outside the intestines and not in the Bao Zhong (uterus), menstruation is unaffected.
Shi Xia (Stone Mass): Originates in Bao Zhong (uterus). Cold pathogen lodges in Zi Men (cervical os). Zi Men closes, Qi cannot flow, evil blood should discharge but does not, blood stasis remains and enlarges daily, resembling pregnancy, with amenorrhea. This occurs only in women and can be treated with guiding and purging methods. Bao refers to the uterus; men have Jing Shi (essence chamber), women have Xue Hai (sea of blood). Cold contention closes Zi Men, blood stasis remains, hard as stone, hence Stone Mass. This affects menstruation and exists only in women.
Shi Shui (Stone Water): Qibo did not answer this in the chapter, likely missing text. *Yin Yang Bie Lun* states: "Yin-Yang knotting obliquely, more Yin less Yang is called Shi Shui, with swollen lower abdomen." The meaning is here, discussed in the Yin-Yang section.
According to *Nei Jing*, treating distension prioritizes removing accumulated stale matter, opening the ghost gate (sweat pores), and cleansing the water reservoir (bladder). Removing stale matter opens stagnation; opening ghost gate induces sweating; cleansing water reservoir promotes diuresis. Treatment focuses on resolving exterior-interior and upper-lower accumulation. *Zhi Zhen Da Yao Lun* states: "All dampness, swelling, and fullness belong to the Spleen." *Shui Re Xue Lun* states: "Its root is in the Kidney, its branch in the Lung, all gathering water." It also says: "The Kidney is the gate of the Stomach. If the gate is obstructed, water gathers following its kind." Discussions on Drum Distension in *Nei Jing* involve not only Zang-Fu but also Wu Yun Liu Qi, Si Tian Zai Quan, and Sheng Fu patterns, yet invariably involve the Spleen, Lung, and Kidney. Spleen transforms and transports essence; Lung governs Qi and regulation; Kidney governs fluids. Fluids transformed by the five Qi belong to the Kidney; Qi moving the five fluids belongs to the Lung; transferring these two organs, generating metal via water, belongs to the Spleen. Thus, swelling arises from dysfunction of these three. However, it must begin with Kidney Qi deficiency, lower Qi rebelling upward, forming through "three combinations." Symptoms mix excess and deficiency. Treating excess must protect deficiency; tonifying deficiency must acknowledge excess. Ultimately, greatly tonifying Spleen and Kidney to secure the root is correct. Zhang Jiabin's *Zhang Lun* should be studied carefully; key points are appended here.
Sudden Pain (Cu Tong)
Sudden pain symptoms vary but stem from cold pathogen entering meridians, circling endlessly, changing and accumulating/stagnating. It may be outside vessels, inside vessels, in intestinal membrane origins, Chong Mai, Jueyin, or Small Intestine. In membrane origin collaterals, or due to rebellion of Yin Qi of five Zang, or rebellion from intestines upward, or lingering bi-heat drying the Small Intestine. Symptoms are manifold. Outside vessels: sudden pain, relieved by warmth, but prolonged if re-exposed to cold. Inside vessels: contends with heat, vessel fullness, pain resists pressure. Severe cases: cold lingers, heat from above fills vessels, Qi-Blood chaotic, severe pain resisting pressure. Below membrane origin: blood cannot disperse, small collaterals tense, causing pain; pressure disperses Qi-Blood, stopping pain. In Chong Mai: rises straight up abdomen, cold rebellion obstruction causes pulsation felt by hand. At spine夾脊: Qi is deep, pressure ineffective. At Back-Shu points: vessel stagnation and blood deficiency cause pain; Shu connects to Heart, causing radiating pain; pressure brings heat, stopping pain. At Jueyin Meridian: Jueyin traverses hypochondrium and lower abdomen, blood stagnation and vessel tension cause radiating pain between hypochondrium and lower abdomen. At inner thigh/lower abdomen: radiating pain. If cold lodges in five Zang, Yin Qi rebels upward, Yang has not entered, causing sudden pain, coma, recovering only when Qi returns. Lodging in intestines/stomach: rebellion upward causes pain and vomiting. Lodging in Small Intestine: failure to consolidate causes abdominal pain and diarrhea. Retaining heat in Small Intestine causes bi-heat, dryness, thirst, intestinal pain, hardness, and constipation. These are all cold-induced. Without cold, vessels are not choppy, and Qi flows freely. Color signs: white for cold, blue-black for pain. Pulse at pain site is firm and choppy; depressed areas are palpable. Treatment: warm them. For heat with closure,酌情 use purgatives. For interior deficiency pain, nourish Yin. For upper deficiency pain (Heart/Spleen injury), tonify Middle. For lower deficiency pain (collapse/Yang loss), urgently rescue and warm Mingmen. This is warming combined with tonification. Who says pain treatment lacks tonification?
Chang Pi (Dysentery/Intestinal Disorder)
Chang Pi forms because Yin cannot overcome Yang; Yang enters Yin and overcomes it, causing heat stagnation in the lower Jiao, impairing the official of transmission. Over time, it forms. Symptoms: frequent urge to defecate without relief, scraping pain, or sound in stool, clustering like crab spit. Similar to modern dysentery, a variant type. Dysentery arises from summer heat and dietary stagnation, manifesting in autumn. Non-seasonal cases are not severe Chang Pi. Chang Pi originates from Jue-Re heat of Foot Three Yin meridians, lingering, combined with Heat Pathogen of Hand Shaoyin and Hand Jueyin moving downward to affect Large Intestine. Though similar to dysentery, it stems from pathogens of the root of all Yins. Yin is Earth Qi, dominant internally. Irregular lifestyle, diet, worry, or sexual excess injure Yin. Yin injury allows Yang to sink downward, entering five Zang and overcoming Yin positions. Yang trapped in Yin cannot ascend, causing痞满 (fullness/blockage), long-term becoming Chang Pi. If lower Qi rebels upward, Yang cannot overcome Yin, causing Pi Zhang (痞胀); if Yin overcomes Yin, cold gathers froth, causing Pi Ji (痞积). Only when five Zang Yin is injured, Yin cannot overcome Yang, causing Yang to sink to lower Jiao and block transmission, resulting in Chang Pi. Classic says: "Overeating causes sinews/vessels to relax, Chang Pi becomes hemorrhoids." This condition, due to heat stagnation and food blockage, prevents Yang from dispersing, sinking to the perineum, causing hemorrhoids. Hemorrhoids are a type of Chang Pi. This condition severely injures Yin, often causing bloody stool, most severely when Kidney transmits to Spleen due to wine and sex excess. Heart/Liver also bleed; wine-injured Spleen causes wine accumulation (white mucus); Hand Shaoyin/Foot Jueyin contention causes pure blood; Kidney transmitting to Spleen causes pus and blood. Treatment: Self-injured intestines/stomach regulate diet, raise Yang to harmonize Yin; from Liver, drain water in Earth; from Kidney, warm Mingmen to raise Middle Earth.
Ru Nü (Malaria-like)
Ru Nü is due to internal righteous Qi deficiency, Liver-Spleen contention, injuring Ying-Wei, with Jueyin, Shaoyang, and Pericardium cold-heat fluctuations, triggered by Si Tian Six Qi Sheng Fu encounters. Symptoms resemble malaria, occurring daily or every other day. Generally, more Yin/fewer Yang delays onset; more Yang/fewer Yin hastens onset. This reflects Sheng Fu contention and waxing/waning rhythms. Cold-heat are Yin-Yang Qi; speed is Yin-Yang nature. Human Yin-Yang is Water-Fire, Ying-Wei. Internal Heart-Kidney non-interaction, Wood-Earth clash cause imbalance. Harmony yields balanced Qi-Blood and regulated interior-exterior; disharmony reveals Sheng Fu timing. Yang entering Yin: Yin cannot overcome Yang, causing heat. Yin exiting Yang: Yang cannot overcome Yin, causing cold. Onset speed depends on Yin-Yang quantity. Regular malaria shares this Yin-Yang entry-exit logic. Difference: presence of pathogen. With pathogen, stop/start depends on Ying-Wei meeting; without pathogen, it depends on Water-Fire contention. One treats pathogen, one supports righteousness; same symptom, different treatment.
Ji (Accumulation/Mass)
Accumulations begin with cold, formed by rebellion. Sudden overeating causes intestinal fullness; irregular living or excessive effort damages collaterals. Yang collateral damage causes external bleeding; Yin collateral damage causes internal bleeding, forming blood stasis. Intestinal collateral damage bleeds outside intestines; cold juices contend with blood, coagulating into masses. Internal injury from fear/worry causes Qi rebellion, blocking six transmissions, stopping warm Qi. External cold combines with internal rebellion, blood coagulates internally, fluids stick and do not leave, forming masses. Meridian Qi rebels with cold. Internal injury to Liver/Kidney/Spleen, external cold rebellion, both rebel downward first, causing cold lower legs, joint pain, and stiffness. Lower leg cold causes Qi-Blood stagnation, entering intestines. Yang fails to transform Qi, juices gather outside intestines. Combined with sudden overeating overwhelming digestion, juices overflow membranes, contend with blood. Effort damages collaterals, blood moves; stasis meets cold, leading to food and blood accumulations.
Xiao Dao (Wasting-Thirst)
Xiao Dao: Xiao means wasting muscles; Dao means internal stagnant heat. Micro-pulses in five Zang indicate Xiao Dao, showing Zang essence failing to fill Ying, with internal heat consuming it. Real-large pulses are favorable, treatable even if chronic. Empty-small-firm pulses indicate essence depletion and blood exhaustion, untreatable. Xiao Dao arises from insufficiency. *Ling Shu* states weak five Zang predispose to Xiao Dao. Weakness implies congenital physical insufficiency. Insufficient Great Qi and Zang Qi lead to Yin deficiency generating internal heat. Unresolved internal heat wastes muscles externally. Obese nobles eating rich foods generate heat, also called Xiao Dao. This differs from San Xiao (Three Thirsts). This is caused by Yin deficiency generating heat in Heart, Kidney, and Liver meridians. Thus, Heat Zhong/Xiao Zhong should not take aromatic herbs or minerals, which provoke mania by激itating fierce Qi, leading to Wood overcoming Earth. Classic warns of changes on Jia-Yi days.
*Nei Jing* Xiao is a category, later known as San Xiao. Lung Xiao/Gai Xiao (*Qi Jue Lun*) and Xiao Ke (*Qi Bing Lun*) are Upper Xiao (polydipsia). Bi becoming Xiao Zhong (*Mai Yao Jing Wei Lun*) and Stomach heat causing hunger (*Shi Chuan Pian*) are Middle Xiao. Frequent turbid urination governed by Liver/Kidney is Lower Xiao. San Xiao forms from Water-Fire non-interaction, dominance, and dry-heat injuring Yin. Five Element contention: Yang excess consumes Yin, Yin excess consumes Yang. Wind-Wood attacking Yangming causes muscle wasting; Heart cold transferring to Lung causes drinking one urinating two (Lung Xiao). Declining Yang with cold Metal/Water causes it. Dry-heat injuring Yin stops Qi transforming water (Xiao); Yin excess, Yang failing to guide, stops water transforming to Qi (Xiao). They are essentially the same.
Dao is another symptom: Pi Dao (Spleen Dao) and Dan Dao (Gallbladder Dao). Pi Dao originates from sweet/greasy foods. Grease causes internal heat; sweetness causes middle fullness. Fullness and stagnant heat cause Qi to overflow upward, turning into Xiao Ke. *Nei Jing* treats with Orchid (Lan) to remove stale Qi. Orchid is sweet-cold, promotes urination, clears Qi to generate fluids, quench thirst, and remove stale heat. Dan Dao presents with bitter taste. Liver relies on Gallbladder; indecision weakens Gallbladder Qi. Weakness causes Qi overflow, bitterness in mouth. Gallbladder meridian meets the throat.